Dx: Rhabdomyolysis resulting in Acute Kidney Injury.
Cause of rhabdo: Likely 2/2 to drug use and lying on the side for too long.
Pts with rhabdo are at risk for heme-induced AKI
Reviewed Total CK, CBC, CMP (esp. BUN, Cr, BUN/Cr, ALT, AST)
Assessed ABCs and patient is currently stable
Admit to telemetry
Cardiac monitor
f/u ECG to monitor effects of hyperkalemia and other electrolyte disturbances.
Will provide supportive care as needed.
IVFs with NS. No K+ additive. Fluid resuscitation is the cornerstone to rhabdo tx.
Insert a Foley catheter for careful monitoring of urine output.
Titrate fluids to keep urine output at least 200 mL/h.
Strict I/Os
Will evaluate and correct electrolyte imbalances.
Serial physical exams to monitor for compartment syndrome and DIC
Monitor creatine kinase (CK) levels to show resolution of rhabdomyolysis.
Repeat CK q 6 hrs to determine the peak CK level.
Repeat BMP q 6hrs
Repeat CMP and CBC in the AM
Renal U/S
Urinalysis
Phosphorus and Magnesium
Will consult nephrology
—/END/—
FYI:
In pts with rhabdomyolysis, almost always get a Renal U/S if AKI is involved. You can’t say 100% that the AKI is from rhabdomyolysis and nothing else contributing to it.
“Statins are a known to cause Rhabdomyolysis.
The urinalysis with a positive dipstick for blood and no RBCs on the microscopic examination is indicative of either hemolysis or rhabdomyolysis. Darkened, pigmented serum would be expected with hemolysis, while rhabdomyolysis is associated with clear serum. Urine abnormalities found in glomerulonephritis include proteinuria and RBC casts, while patients with allergic interstitial nephritis may have eosinophils and possibly WBC casts. Pyelonephritis is associated with WBCs in the urine, and if the dipstick is positive for blood there will be RBCs on the microscopic examination.” ABFM
Resources:
http://emedicine.medscape.com/article/1007814-treatment
http://www.uptodate.com/contents/prevention-and-treatment-of-heme-pigment-induced-acute-kidney-injury-acute-renal-failure
Am Fam Physician2012;86(7):631-639.